Echocardiographic right ventricular strain from multiple apical views is superior for assessment of right ventricular systolic function

• Published in: Clinical physiology and functional imaging Vol. 39; no. 2; pp. 168 - 176
• Main Authors: Werther Evaldsson, A., Ingvarsson, A., Smith, J. G., Rådegran, G., Roijer, A., Waktare, J., Ostenfeld, E., Meurling, C.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-03-2019
• Subjects: Aged; Cardiac and Cardiovascular Systems; Clinical Medicine; Correlation analysis; Correlation coefficient; Correlation coefficients; Echocardiography; Echocardiography - methods; Female; Heart; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hypertension; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - physiopathology; Kardiologi; Klinisk medicin; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Muscle contraction; Parameters; Patients; Predictive Value of Tests; Radiologi och bildbehandling; Radiology, Nuclear Medicine and Medical Imaging; Reproducibility of Results; right ventricular bullseye plot; right ventricular ejection fraction; right ventricular global longitudinal strain; right ventricular systolic function; speckle tracking; Stroke Volume; Systole; Ventricle; Ventricular Function, Right; speckle tracking; right ventricular ejection fraction; right ventricular systolic function; right ventricular bullseye plot; right ventricular global longitudinal strain
• ISSN: 1475-0961; 1475-097X
• DOI: 10.1111/cpf.12552

Summary
Background
Right ventricular (RV) systolic function is an important determinant of outcome in patients with pulmonary hypertension (PH). Conventional echocardiographic measures of RV are mainly based on longitudinal contractility. Recently, measurement of RV global longitudinal strain derived from multiple windows (RVGLS) has emerged as an option but has not been well evaluated. The aim of the present study was to evaluate which echocardiographic RV function parameter correlates best with RV ejection fraction derived from cardiac magnetic resonance imaging (RVEFCMR).
Methods and results
Fifty‐five patients evaluated for PH underwent RV assessment with echocardiography and CMR. Conventional echocardiographic parameters of RV function including tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (S′), RV fractional area change (RVFAC) and RV index of myocardial performance (RIMP). RVGLS was measured from three separate apical views using a 17‐segment model and strain from the lateral free wall was calculated separately (RVfree). The study included 55 patients, whereas assessment of RVGLS could be obtained in 29 patients. The Pearson correlation coefficient with RVEFCMR was strong for RVGLS (r = 0·814, P<0·001) and RVfree (r = 0·778, P<0·001), modest for RVFAC (r = 0·681, P<0·001), TAPSE (r = 0·592, P<0·001) and RIMP (r=−0·521, P<0·01), and weak for S′ (r = 0·385, P<0·01).
Conclusion
The echocardiographic RV measures, RVGLS and RVfree correlated well with RVEFCMR, whereas correlation with TAPSE, RIMP and S′ was unsatisfactory. Our findings suggest that RVGLS and RVfree are the preferred echocardiographic methods for clinical practice. RVfree is easiest to perform but RVGLS could provide incremental value in selected patients.